Dulaglutide Reduces Binge Eating in Pilot Study in Diabetes

BARCELONA, Spain — Dulaglutide (Trulicity, Lilly) treatment reduces binge eating in patients with type 2 diabetes and binge eating disorder, and was associated with rapid and significant reductions in weight and glycemia compared with gliclazide, shows the first study of a glucagon-like peptide-1 (GLP-1) receptor agonist in this setting.

Results were reported on September 19 by Andrea Da Porto, MD, from the University of Udine, Italy, here at the European Association for the Study of Diabetes (EASD) 2019 Annual Meeting.

"Compared to [the sulfonylurea] gliclazide, dulaglutide therapy was efficient in reducing binge eating behavior and was associated with a greater decrease in body weight and A1c," he reported.

"In particular, we saw an effect on body weight that is greater than that expected with GLP-1 [agonist] treatment after a few weeks," he said.

"Dulaglutide could be considered as a valid option in the treatment of type 2 diabetes with binge eating disorder," Da Porto asserted.

Moderator Jens Holst, MD, DMSc, from the University of Copenhagen, Denmark, who discovered the GLP-1 hormone in the 1980s, welcomed the research and said it was good to see the effect on binge eating because it is a clinical problem in type 2 diabetes.

However, he cautioned, "the study design is poor due to use of a sulfonylurea in the control group, so it's impossible to know how much of the effect is due to the weight increasing effect of the sulfonylurea...surely, they should have used a dipeptidyl peptidase-4 (DPP4) inhibitor [as a comparator]?"

Nevertheless, "In principle, I don't think it detracts a lot from the observation that it [the GLP-1 agonist] is helpful in binge eating," he said.

He added that the findings are consistent with "other" research.

Da Porto noted there have previously been isolated clinical case reports of improvements in binge eating with GLP-1 agonists.

Binge Eating More Common in Type 2 Diabetes Population

Binge eating disorder is often accompanied by a feeling of loss of control during the binge and negative feelings about oneself, but without intervening periods of compensatory behavior, said Da Porto.

Binge eating sessions must occur once a week for 3 months, according to the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

And it is more prevalent in the type 2 diabetes population, affecting up to 40% of individuals — although the range affected varies greatly in the literature, he noted — compared with around 2.5% of people in the general population.

"Not only are those with binge eating disorder more likely to develop obesity, at three to six times the risk in the general population, but in people who also have type 2 diabetes, it can be an obstacle to successful treatment," Da Porto explained.

"Also, high scores on the binge eating scale [BES] have been linked to the highest levels of A1c," he added.

Da Porto went on to explain that human neuroimaging shows GLP-1 receptor activation decreases brain responses to the anticipation of food.

"Altogether, studies suggest GLP-1 receptor activation might have an effect on the anticipatory consumption of food as a reward and will counteract cravings and overeating," he said.

Reductions in Binge Eating, Weight, and A1c With Dulaglutide

In the current study, all 60 patients with type 2 diabetes were initially on metformin monotherapy, were younger than age 65 years, and had normal renal and hepatic function, with an average A1c of 7.9%.

Participants had a mean weight of 99 kg (218 lb), nearly 80% were obese with a mean body mass index (BMI) of 36 kg/m² and a mean body fat mass of 37%.

The average score on the binge eating scale was 23.7, indicating an intermediate severity of binge eating.

Participants additionally received either dulaglutide (subcutaneously, 1.5 mg/week) or gliclazide (60 mg/day slow release) for 12 weeks.

All patients also received standard education on lifestyle and diet.

"After 12 weeks of treatment, patients on dulaglutide showed a significantly greater reduction in binge eating severity (change in BES, –12.07 vs –0.47; P < .0001)," Da Porto reported.

Those taking dulaglutide also had greater reductions in BMI (–1.65 vs 0.04 kg/m²; P < .0001) and weight (–4.77 vs 0.07 kg; P < .0001).

And A1c was reduced to a greater degree with dulaglutide compared with gliclazide (–1.07 vs –0.75 percentage points; P = .009).

"The reduction in binge eating severity was independently associated with a reduction in body weight and A1c even after adjustment for age and sex," reported Da Porto.

Limitations include the fact that the trial was conducted in a small number of patients and follow-up was short, he said. And there is a known reduction in appetite during the first few weeks of treatment with GLP-1 receptor agonists, he added.

Nevertheless, no patient stopped dulaglutide therapy because of gastrointestinal side effects.

Further studies in this specific patient population, with a greater number of patients, different comparator drugs, and longer follow-up are needed, he concluded.

Da Porto has reported no relevant financial relationships. Holst has consulted for Novo Nordisk in the past.

EASD 2019. Presented September 19, 2019.

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